Long-Term Risk of Dementia up to Three Decades After Total Joint Arthroplasty: A Population-Based Cohort Study

Individuals who have had total joint arthroplasty (TJA) are subject to lifelong exposure to metal-based implants. The relationship between chronic exposure to metal-based implants and systemic effects on the brain remains unclear. We aimed to determine the association between TJA and the subsequent long-term risk of dementia.

We assembled a retrospective, population-based cohort of 7,329 subjects who first had total hip arthroplasty (THA) or total knee arthroplasty surgery between 1990 and 2020 and 7,472 age-, sex-, and calendar year-matched non-TJA subjects. After excluding subjects in whom dementia was diagnosed before the index date, all subjects were followed up until either death, incident dementia (defined as a clinician diagnosis), loss to follow-up, or February 2020. Detailed information from the complete medical records was collected regarding surgical history, dementia diagnoses, and other risk factors. At baseline, TJA subjects had a higher prevalence of several comorbidities than the non-TJA subjects. Poisson regression models with time-dependent covariates were used to estimate the risk of dementia among TJA subjects, accounting for the competing risk of death and comorbidities.

During the first decade of follow-up after surgery, both the THA (hazard ratio [HR]: 0.84, 95% confidence intervals [CI] 0.73 to 0.97) and total knee arthroplasty (HR 0.73, 95% CI 0.63 to 0.84) subjects had a lower risk of dementia compared to the non-TJA subjects. Subjects who had THA for fracture had a higher risk of dementia (HR 1.23, 95% CI: 1.02 to 1.50), whereas those who had osteoarthritis had a lower risk than the non-TJA subjects. The risk of dementia was similar to the general population beyond the first decade after surgery. There were no differences in the risk of dementia between titanium and cobalt-chromium-containing implants.

Total joint arthroplasty was not associated with an increased risk of dementia.